(1) The temporal trend in the age-standardized mortality rate (ASMR) of CVD (including IHD and stroke) attributable to TE from 1990 to 2017
Smoking: For both sexes, the ASMR of CVD attributable to smoking in China, Japan, USA and world significantly decreased by 0.4% (95%CI: 0.0%-0.7%), 4.0% (95%CI: 3.7%-4.3%), 4.9% (95%CI: 4.7%-5.1%) and 2.1% (95%CI: 1.8%-2.4%) per year, respectively (Figure 1). The ASMR of IHD attributable to smoking in Japan, USA and world significantly decreased by 4.2% (95%CI: 3.9%-4.5%), 5.1% (95%CI: 4.9%-5.3%) and 2.2% (95%CI: 2.0%-2.4%) per year, but increased by 0.6% (95%CI: 0.1%-1.0%) in China (Figure S1); There were significant downward trends in the ASMR of stroke attributable to smoking in China, Japan, USA and world. Though China was not the first rank in 1990, China was the first rank in 2017 (Figure S2). The change of CVD, IHD and stroke attributable to smoking in male and female was similar to those in both sexes in each region. The above detailed results were shown in table 1.
Table 1. The temporal trend in mortality rate of CVD, IHD and stroke attributable to smoking in China, Japan, USA and the world from 1990 to 2017.
Figure 1. The ASMR of CVD attributable to smoking in China, Japan, USA and the world from 1990 to 2017.
Figure S1. The ASMR of IHD attributable to smoking in China, Japan, USA and the world from 1990 to 2017.
Figure S2. The ASMR of stroke attributable to smoking in China, Japan, USA and the world from 1990 to 2017.
Secondhand smoke: For both sexes, the ASMR of CVD attributable to SHS in China, Japan, USA and the world significantly decreased by 1.2% (95%CI: 0.7%-1.7%), 3.8% (95%CI: 3.5%-4.1%), 3.9% (95%CI: 3.6%-4.2%) and 1.8% (95%CI: 1.5%-2.0%) per year, respectively (Figure S3). The ASMR of IHD attributable to SHS in Japan, USA and world significantly decreased by 3.8% (95%CI: 3.5%-4.0%), 4.1% (95%CI: 3.8%-4.4%) and 1.6% (95%CI: 1.3%-1.9%) per year, but there was no significant trend change in China (Figure S4); There were significant downward trends in the ASMR of stroke attributable to SHS in China, Japan, USA and world (Figure S5). The change of CVD, IHD and stroke attributable to SHS in male and female was similar to those in both sexes in each region. The above detailed results were shown in table S1.
Table S1. The temporal trend in mortality rate of CVD, IHD and stroke attributable to SHS in China, Japan, USA and the world from 1990 to 2017.
Figure S3. The ASMR of CVD attributable to secondhand smoke in China, Japan, USA and the world from 1990 to 2017.
Figure S4. The ASMR of IHD attributable to secondhand smoke in China, Japan, USA and the world from 1990 to 2017.
Figure S5. The ASMR of stroke attributable to secondhand smoke in China, Japan, USA and the world from 1990 to 2017.
(2) The APC analysis in the mortality rate of CVD (including IHD and stroke) attributable to TE from 1990 to 2017
Smoking: For both sexes, in the same birth cohort, the mortality rate of CVD attributable to smoking rapidly increased 7.38 (95%CI: 6.34, 8.58) per 100,000 in age group 30-34 to 360.15 (95%CI: 338.97, 382.67) per 100,000 in age group 75-79 in China. The similar changes could be observed in Japan, USA and the world (Figure 2A). The mortality rate of IHD and stroke attributable to smoking also increased from age group 30-34 to age group 75-79 (Figure S6A and Figure S7A). All the period RRs of CVD and stroke showed a decreasing trend from 1990 to 2017 in four regions (Figure 2B and Figure S7B). The period RRs of IHD in Japan, USA and the world also showed a downward trend from 1990 to 2017. In China, the period RRs of IHD showed a downward trend, and then showed an upward trend (Figure S6B). All the cohort RRs of CVD and stroke showed a decreasing trend in four regions (Figure 2C and Figure S7C). The cohort RRs of IHD in Japan, USA and the world also showed a downward trend from 1990 to 2017, but the cohort RRs of IHD showed an upward trend, and then showed a downward trend (Figure S6C). The effects of age, period and cohort on CVD, IHD and stroke attributable to smoking in male and female were similar to those in both sexes in each region.
For CVD, the overall net drifts per year in China, Japan, USA and the world were below zero. For IHD, the overall net drifts per year in Japan, USA and the world were below zero, and 0.01% (95%CI: -0.22%, 0.23%) in China. For stroke, the overall net drifts per year in China, Japan, USA and the world were below zero. All the local drift values increased by age groups in China, decreased in Japan and USA, and fluctuated in the world (Figure S8). The change of CVD, IHD and stroke in male and female was similar to those in both sexes in each region. The above detailed results were shown in table 2.
Table 2. The net drift value of the mortality rate of CVD, IHD and stroke attributable to smoking.
Figure 2. The APC results of CVD attributable to smoking in China, Japan, USA and the world from 1990 to 2017.
Figure S6. The APC results of IHD attributable to smoking in China, Japan, USA and the world from 1990 to 2017.
Figure S7. The APC results of stroke attributable to smoking in China, Japan, USA and the world from 1990 to 2017.
Figure S8. The local drift with net drift values of the mortality rate of CVD, IHD and stroke attributable to smoking.
Secondhand smoke: All the results were similar to those of smoking for each disease in each region. The above detailed results were shown in table S2.
Table S2. The net drift value of the mortality rate of CVD, IHD and stroke attributable to secondhand smoke.
Figure S9. The APC results of CVD attributable to secondhand smoke in China, Japan, USA and the world from 1990 to 2017.
Figure S10. The APC results of IHD attributable to secondhand smoke in China, Japan, USA and the world from 1990 to 2017.
Figure S11. The APC results of stroke attributable to secondhand smoke in China, Japan, USA and the world from 1990 to 2017.
Figure S12. The local drift with net drift values of the mortality rate of CVD, IHD and stroke attributable to secondhand smoke.